To assess the effects of the B lymphocyte stimulator (BLyS)-specific inhibitor belimumab on immunologic biomarkers, including B cell and T cell populations, and maintenance of antibody titers to prior vaccines in autoantibody-positive systemic lupus erythematosus (SLE) patients.Pooled data from 2 phase III trials, the Study of Belimumab in Subjects with SLE 52-week (BLISS-52) and 76-week (BLISS-76) trials, comparing belimumab 1 mg/kg or 10 mg/kg versus placebo (plus standard SLE therapy for each group) were analyzed for changes in autoantibody, immunoglobulin, and complement levels. BLISS-76 patients were also analyzed for changes in B cell and T cell populations and effects on prior vaccine-induced antibody levels.Belimumab-treated patients experienced significant sustained reductions in IgG and autoantibodies and improvement in C3/C4 levels, resulting in greater positive-to-negative conversion rates for IgG anti-double-stranded DNA (anti-dsDNA), anti-Sm, anticardiolipin, and anti-ribosomal P autoantibodies and normalization of hypergammaglobulinemia and low C3/C4 levels. Belimumab-treated patients experienced significant decreases in the numbers of naive and activated B cells, as well as plasma cells, whereas memory B cells and T cell populations did not decrease. Belimumab did not substantially affect preexisting antipneumococcal or anti-tetanus toxoid antibody levels. Post hoc analysis showed greater reductions in SLE disease activity and the risk of severe flares in patients treated with belimumab 10 mg/kg (P≤0.01) who were anti-dsDNA positive and had low C3/C4 levels at baseline. Normalization of the C3 or anti-dsDNA level by 8 weeks, irrespective of therapy, was predictive of a reduced risk of severe flare over 52 weeks.Belimumab appears to promote normalization of serologic activity and reduce BLyS-dependent B cell subsets in serologically and clinically active SLE. Greater serologic activity may predict a better treatment response to belimumab.

Belimumab

10.1002/art.34400

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Trends in all-cause hospitalizations for systemic lupus erythematosus in Mexico, 2000–2019

Lupus (2022)

Claudia Mendoza‐Pinto Ivet Etchegaray‐Morales Pamela Munguía‐Realpozo Juan Carlos Solís-Poblano Socorro Méndez‐Martínez

Background Hospitalizations due to systemic lupus erythematosus (SLE) incur substantial resource use. Hospitalization trends provide a key benchmark of the disease burden. However, there is little long-term data in Mexico. Therefore, we evaluated Mexican hospitalization trends for SLE during 2000–2019. Methods Hospitalization trends of SLE were studied using data from 2000 to 2019 releases of the National Dynamic Cubes of the General Direction of Health Information, which provides data on hospitalization discharges in Mexico. Patients aged ≥15 years hospitalized during the study period with a principal discharge diagnosis of SLE (ICD-10 code M32) were included. Results From 2000 to 2019, there were 17,081 hospitalizations for SLE, of which 87.6% were in females and 87% in subjects aged 15–44 years. From 2000 to 2019, the age-standardized hospitalization rate for patients with SLE increased from 0.38 per 100,000 persons to 0.65 per 100,000 persons with an average annual percentage change (APC) of 2.9% (95% CI 6.2–63.2). Although there was a significant uptrend from 2000 through 2011, there was a significant decline from 2011 to 2019 (APC: −4.8%, 95% CI −7.0% to −2.5%). Similar trends were identified in subjects aged 15–44 years and in both sexes. The length of stay and inpatient mortality decreased between 2000–2009 and 2010–2019. Conclusions Although there was a substantial increase in SLE hospitalizations in 2000–2019, in 2011–2019, a decreased trend was reported in younger patients and in females and males. The length of stay was also reduced.

10.1177/09612033221128745

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Are steroids required for induction therapy and relapses in lupus nephritis?

Annals of the Rheumatic Diseases (2013)

Carlos Abud‐Mendoza Roberto González‐Amaro

‘A finger in the wound’, is an expression by Condon et al 1 used in their very interesting paper treating severe lupus nephritis with rituximab and mycophenolate, additionally to intravenous methyl-prednisolone, but not long-term oral steroids, achieving a good clinical response in most patients. Rheumatologists and nephrologists have the notion that glucocorticoids are the cornerstone for the treatment of autoimmune diseases, particularly lupus nephritis, where steroids …

Prednisolone

Nephritis

10.1136/annrheumdis-2013-204321

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LP-149 Latin-American systemic lupus erythematosus clusters

Rosana Quintana Romina Nieto Guillermo J. Pons‐Estel J. Gόmez Puerta Guillermina Harvey

Background

Systemic lupus erythematosus (SLE) is heterogeneous autoimmune disease. Identification of patient clusters may be useful for the management of the disease. The aim of this study is to describe different SLE clusters according to sociodemographic, clinical and serological characteristics.

Methods

GLADEL 2.0 is an ongoing Latin-American observational cohort initiated in 2019. Variables chosen at cohort entry to stratify patients and construct clusters were selected from sociodemographic and cumulative clinical and serological variables. Hierarchical cluster analyses were performed by the Ward method on a distance matrix using the Gower's method.

Results

A total of 560 SLE patients were included in this analysis. Three clusters were identified. Cluster 1 (n=269) was characterized by more cutaneous, articular, renal and serosal involvement; serological manifestation was positive anti-dsDNA. Cluster 2 (n=194) was represented by patients who rarely had renal involvement and the most frequent clinical manifestations were cutaneous and hematological; the most frequent serological manifestations were the presence of antiphospholipid antibodies (aPLs). Cluster 3 (n=97) was characterized by a lower frequency of clinical and serological involvements, with the exception of neurological domain. Clusters 1 and 2 share hematologic manifestations and hypocomplementemia (table 1).

Conclusions

In this cohort, three clusters were identified. Cluster 1 patients were characterized by renal, articular, cutaneous and serositis involvement, anti-dsDNA antibodies and hypocomplementemia, Cluster 2 patients were characterized by hematologic, cutaneous involvement, aPLs and hypocomplementemia. Cluster 3 patients presented fewer serological findings but a higher frequency of neurological involvement. Follow up of these patients will allow for elucidation of relationship of these clusters with SLE outcomes.

Serositis

10.1136/lupus-2023-kcr.235

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Enfermedades relacionadas con IgG4 (IgG4-RD), con horizonte no limitado a la enfermedad de Mikulicz

Reumatología Clínica (2013)

Carlos Abud‐Mendoza

10.1016/j.reuma.2013.02.003

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Expression and function of IL‐10R in mononuclear cells from patients with systemic lupus erythematosus

Scandinavian Journal of Rheumatology (2006)

Guillermo Valencia‐Pacheco Esther Layseca‐Espinosa Perla Niño-Moreno Diana Patricia Portales‐Pérez Lourdes Baranda

Objective: To assess the expression and function of the receptor for interleukin‐10 (IL‐10R) in immune cells from patients with systemic lupus erythematosus (SLE).Methods: We assessed the expression and function of IL‐10R in peripheral blood mononuclear cells (PBMCs) from 19 SLE patients and 15 healthy controls. The expression of IL‐10R was assessed by flow cytometry, and the function of this receptor was determined by analysing both the activation of Jak‐1, Tyk‐2, Stat‐1, and Stat‐3 (Western blot) and the induction of gene expression (cDNA array test of 242 genes of cytokines, apoptosis and intracellular signalling) upon stimulation with IL‐10.Results: We found similar levels of IL‐10R expression in SLE patients and controls. In addition, variable levels of Jak‐1, Tyk‐2, Stat‐1, and Stat‐3 activation were induced by IL‐10 in PBMCs from SLE patients and controls, with no significant differences in protein phosphorylation or kinetics of activation. However, clear‐cut differences in the gene expression induced through IL‐10R were observed in SLE patients and controls, mainly in the genes involved in apoptosis and those encoding for cytokines and their receptors.Conclusions: Our data suggest that despite normal levels of IL‐10R expression, and an apparent lack of abnormalities in the intracellular signals induced through this receptor, immune cells from SLE patients exhibit an aberrant pattern of gene expression induced through the IL‐10R.

10.1080/03009740600709840

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Citations (13)